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NAME
<br />Kittitas, The County of
<br />Doing business as (DBA)
<br />Kittitas County
<br />ADDRESS
<br />205 W 5th Ave Ste 105
<br />Ellensburg, WA 98926
<br />Appllcable Procurament
<br />or Sollcnatlon #, lf any:
<br />WA Uniform Business
<br />ldentlfier (UBl)
<br />192002673
<br />Federal EmployerTax
<br />ldentificalion *:
<br />91-6001349
<br />Thb caillllcatlon ls submltted as oart ol a r€qusst lo contracl.
<br />Washington M ilitary Department Contract N umber:ff
<br />Debarment, Suspension, lneligibility or Voluntary Exclusion Certification Form
<br />lnstructions For Certification Regardlng Debarment, Suspenslon, lnellglbility and Voluntary Exclusion-'Lower
<br />Tier Govered Transactions
<br />READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulatlons require contractors and bldderc to sign and
<br />abide by the torms of this csrtlflcetlon, without modiflcatlon, ln order to partlclpate ln certaln traneactlons dlrectly
<br />federal funds
<br />1. By signing and submifting this proposal, the prospective lower tier participant is providing the cefiification set out
<br />below
<br />2. The cerlification in lhis clause is a material reprasentation of fact upon which relianoe was placed when this
<br />transaction was entered into. lf it is later determined that the prospective lower tier participant knowingly rendered an
<br />erroneous certification, in addtion to other remedies available to the FederalGovernment the department or agency
<br />with which this transaction originated may pursue available remedies, including suspension and/or debarment.
<br />3. The prospective lower tier parlicipant shall provide immediate written notice to lhe department, institution or office to
<br />which this proposal is submifted if at any time the prospective lower tier participant learns that its certification was
<br />arroneous when submitted or had become erroneous by reason of changed circumstances.
<br />4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, pelson,
<br />primary covered transaction, prineipal, proposal, and voluntarily excluded, as used in this clause, have the meaning
<br />sel out in lhe Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
<br />person to which this proposal is submitted for assistance in obtaining a copy of those regulatbns.
<br />5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
<br />transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
<br />proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or volunlarily excluded
<br />from participation in this covered transaction, unless authorized by the department or agency with which this
<br />transaction originated.6. The prospective lower tier participanl further agrees by submitting this proposal that it will include this clause titled
<br />"Certification Regarding Debarment, Suspension, lneligibility and Voluntary Exclusion-Lower Tier Covered
<br />Transaction," without modificaiion, in all lower tier covered transactions and in all solicilations for lower tier covered
<br />lransaclions.
<br />7, A participant in a covered transaclion may rely upon a certification of a prospective parlicipant in a lower tier covered
<br />transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
<br />excluded from covered transactions, unless it knows that the certification is enoneous. A participant may decide the
<br />method and frequency by which il determines the eligibility of its pdncipals. Each participant may, but is not required
<br />to, check the List of Parties Excluded from Federal Procurement and Non-procurement Programs.
<br />8. Nolhing contained in the foregoing shall be construed to require establishment of a system of records in order to
<br />render in good faith the cerlificaiion required by this clause. The knowledge and information of a participant is not
<br />required to exceed that which is normally possessed by a prudent per$on in the ordinary course of business activity'
<br />9. Except for transactions authorized under paragraph 5 of these inslructions, if a participant in a covered transaction
<br />knowingly enters into a lower tier covered traniaction wilh a person who is proposed for debarment under applicable
<br />CFR, suspended, debarred, ineligible, or voluntarily excluded from participalion in this transaction, in addition to other
<br />remedies available to the Federal Government, the department or agency wifr which this transaction originated may
<br />pursue available remedies, including suspension and/or debarment.
<br />Certification Regardlng Debarment, Suspenslon, lneligibillty and Voluntary Exclusion-Lower Tier
<br />Govered Transactions
<br />The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor lts
<br />prlncipals ls presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarlly excluded
<br />from particlpation ln this transaction by any Federal department or agency. Where the prospective lower tier
<br />particlpant irs unable to ceilify to any of the statements in thls certiflcatlon, such prospectlve participant shall
<br />attach an explanation to this form.
<br />Bidder or Contraclor Signature:
<br />>Print Name and Title:
<br />Date:7
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